Predictors of drop-out in overweight and obese outpatients

Temporal Aspects of Psychosocial Mediators of the Exercise-Weight Loss Maintenance Relationship Within Scalable Behavior-Change Treatments

STUDY BACKGROUND

Limited knowledge of psychological correlates of weight loss is associated with continuing failures of behavioral obesity treatments beyond the short term.

PURPOSE

This study aimed to inform health professionals' obesity interventions via an increased knowledge of mediators of the exercise-weight loss maintenance relationship.

METHODS

Women participated in 6-month obesity treatments within community settings emphasizing moderate exercise and self-regulation skills development via primarily in-person (n = 54) or primarily written (n = 54) means. Changes in mood, self-regulating eating, and weight over 6, 12, and 24 months were assessed. A moderated mediation model was tested using the PROCESS macro instruction.

RESULTS

Improvements in mood, self-regulating eating, and weight were significantly greater in the in-person group. The relationship between a dichotomous measure of completing at least 3 sessions of exercise per week (or not) and change in weight over 6 months was no longer significant when the mediators of changes in negative mood and self-regulation of eating were sequentially entered. Paths of exercise→negative mood reduction→eating self-regulation increase→weight loss over 6, 12 and 24 months were significant. Exercise self-regulation at Month 3 significantly moderated the mood change→eating self-regulation change relationship.

CONCLUSIONS

Based on the identified paths, scalable obesity-treatment content and emphases were informed. This could help guide health professionals' actions concerning the management of obesity.

Comparison of the Efficacy of Anti-Obesity Medications in Real-World Practice

Purpose

Anti-obesity medications (AOMs), along with lifestyle interventions, are effective means of inducing and maintaining weight loss in patients with obesity. Although the efficacy of AOMs has been reported, there have been no direct comparisons of these drugs. Therefore, in the present study, we aimed to compare the efficacy of all the AOMs available in Korea in a real-world setting.

Patients and Methods

The body weight and composition of 205 adults treated with phentermine, phentermine/topiramate, liraglutide, naltrexone/bupropion, lorcaserin, or orlistat for at least 6 months were analyzed at 2 month intervals. The prevalence of the achievement of a ≥5% weight loss and the changes in body composition were compared between participants using each AOM at each visit.

Results

A total of 132 (64.4%) participants achieved ≥5% weight loss within 6 months (prevalence of ≥5% weight loss after 6 months: phentermine, 87.2%; phentermine/topiramate, 67.7%; liraglutide, 58.1%; naltrexone/bupropion, 35.3%; lorcaserin, 75%; orlistat, 50%). At each visit, after adjustment for age, sex, and baseline body weight, phentermine use was associated with a significantly higher prevalence of ≥5% weight loss than the use of the other AOMs, except for liraglutide. There were significant differences in the body weight, body mass index and body fat mass among the AOM groups by visit (P for interaction <0.05), but not in their waist circumference, skeletal muscle mass, percentage body fat, or visceral fat area.

Conclusion

All the AOMs were effective at inducing and maintaining weight loss, in the absence of significant changes in muscle mass, over a 6 month period, and the short-term use of phentermine and the long-term use of phentermine/topiramate or liraglutide would be practical choices for the treatment of obesity. However, further, large-scale studies are necessary to confirm these findings.

Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study

BACKGROUND

Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy.

OBJECTIVE

This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase.

METHODS

The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes.

RESULTS

Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model.

CONCLUSIONS

The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner.

Bilateral Subdiaphragmatic Vagal Nerve Stimulation Using a Novel Waveform Decreases Body Weight, Food Consumption, Adiposity, and Activity in Obesity-Prone Rats

INTRODUCTION

Obesity affects millions of Americans. The vagal nerves convey the degree of stomach fullness to the brain via afferent visceral fibers. Studies have found that vagal nerve stimulation (VNS) promotes reduced food intake, causes weight loss, and reduces cravings and appetite.

METHODS

Here, we evaluate the efficacy of a novel stimulus waveform applied bilaterally to the subdiaphragmatic vagal nerve stimulation (sVNS) for almost 13 weeks. A stimulating cuff electrode was implanted in obesity-prone Sprague Dawley rats maintained on a high-fat diet. Body weight, food consumption, and daily movement were tracked over time and compared against three control groups: sham rats on a high-fat diet that were implanted with non-operational cuffs, rats on a high-fat diet that were not implanted, and rats on a standard diet that were not implanted.

RESULTS

Results showed that rats on a high-fat diet that received sVNS attained a similar weight to rats on a standard diet due primarily to a reduction in daily caloric intake. Rats on a high-fat diet that received sVNS had significantly less body fat than other high-fat controls. Rats receiving sVNS also began moving a similar amount to rats on the standard diet.

CONCLUSION

Results from this study suggest that bilateral subdiaphragmatic vagal nerve stimulation can alter the rate of growth of rats maintained on a high-fat diet through a reduction in daily caloric intake, returning their body weight to that which is similar to rats on a standard diet over approximately 13 weeks.

The effects of eating frequency on changes in body composition and cardiometabolic health in adults: a systematic review with meta-analysis of randomized trials

BACKGROUND

Eating frequency may affect body weight and cardiometabolic health. Intervention trials and observational studies have both indicated that high- and low-frequency eating can be associated with better health outcomes. There are currently no guidelines to inform how to advise healthy adults about how frequently to consume food or beverages.

AIM

To establish whether restricted- (≤ three meals per day) frequency had a superior effect on markers of cardiometabolic health (primary outcome: weight change) compared to unrestricted-eating (≥ four meals per day) frequency in adults.

METHODS

We searched Medline (Ovid), Embase, CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), CAB Direct and Web of Science Core Collection electronic databases from inception to 7 June 2022 for clinical trials (randomised parallel or cross-over trials) reporting on the effect of high or low-frequency eating on cardiometabolic health (primary outcome: weight change). Trial interventions had to last for at least two weeks, and had to have been conducted in human adults. Bias was assessed using the Cochrane Risk of Bias tool 2.0. Standardized mean differences (SMD) and 95% confidence intervals were calculated for all outcomes. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Seventeen reports covering 16 trials were included in the systematic review. Data from five trials were excluded from meta-analysis due to insufficient reporting. 15 of 16 trials were at high risk of bias. There was very low certainty evidence of no difference between high- and low-frequency eating for weight-change (MD: -0.62 kg, CI95: -2.76 to 1.52 kg, p = 0.57).

CONCLUSIONS

There was no discernible advantage to eating in a high- or low-frequency dietary pattern for cardiometabolic health. We cannot advocate for either restricted- or unrestricted eating frequency to change markers of cardiometabolic health in healthy young to middle-aged adults.

PROTOCOL REGISTRATION

CRD42019137938.

Relationship between adherence to dietary treatment and binge-eating disorder in obese patients

Introduction

Introduction: the binge eating disorder (BED) is the eating disorder that most affects the obese population, and BED is an aspect that possibly interferes with the rate of adherence to nutritional treatment, which is also low in individuals with chronic non-communicable disease. Objective: to examine the relationship between adherence to dietary treatment and BED presence in obese individuals. Methods: this cohort study was conducted with a sample of 73 obese individuals at a nutrition and metabolic disease outpatient unit. Anthropometric data were collected, and a three-day food record was used for dietary assessment. BED was identified using the Binge Eating Scale, and patients were divided into two groups (BED and non-BED controls). Patients were reassessed at three-month follow-up. Data were analyzed using Student's t-tests and generalized estimating equations with Bonferroni correction. Adherence to dietary treatment was assessed by calculating differences between recommended and actual energy intakes. Results: BED was identified in 28.7 % of obese individuals. There was no significant difference in adherence to dietary treatment between BED and control patients. Both groups showed similar eating habits and physical activity levels throughout the study period. Conclusion: obesity is one of the factors contributing to the lack of adherence to nutritional guidelines. The importance of cognitive methods in dietary treatment programs should be further investigated.

Assessing service provision and outcomes at the Canberra Obesity Management Service: A retrospective chart review

OBJECTIVE

This study aimed to evaluate the multidisciplinary care model of the Canberra Obesity Management Service (COMS) with regard to patient demographics and clinical outcomes, particularly in comparison with previous COMS outcome reviews.

METHODS

A retrospective chart review was carried out on all patients attending an initial assessment at COMS between July 2018 and June 2019. Existing patients attending follow-up reviews were excluded so as to avoid repeating analyses of data from previous COMS reviews. Patient data were recorded and deidentified and underwent descriptive analyses.

RESULTS

A total of 234 patients with a mean age of 45.6 (SD = 13.9) years, mean BMI of 50.1 kg/m² (SD = 8.5), and a female majority (72.2%) were analyzed. Of the 165 patients who attended follow-up appointments, 27.9% experienced ≥10% weight loss (46/165). Sleeve gastrectomy was associated with the largest mean weight reduction (15.6% at 6 months [n = 18]).

CONCLUSIONS

Compared with previous COMS studies, both the throughput and proportion of participants achieving clinically meaningful weight reduction were observed to have increased. Further studies assessing service cost-effectiveness, the development of standardized treatment pathways, and the use of a systematic data collection system would be valuable in allowing comparison between outcomes with similar obesity services in Australia and internationally.

Circulating Anti-Müllerian hormone in a cohort-study of women with severe obesity with and without polycystic ovary syndrome and the effect of a one-year weight loss intervention

BACKGROUND

Women with polycystic ovary syndrome (PCOS) have high circulating anti-Müllerian hormone (AMH) levels which is correlated with antral follicle count and polycystic ovarian morphology and negatively correlated with body mass index (BMI). Moreover, diet-induced weight loss in women with PCOS and overweight or obesity, reduce or normalize AMH-levels. There is, however, no previous study investigating the circulating AMH levels in women with severe obesity and how a structured diet-induced weight loss program affects circulating AMH levels in these women. Therefore, this study aims to investigate circulating AMH levels in a population of women with severe obesity (BMI ≥ 35 kg/m²) with and without PCOS, as diagnosed by the NIH-criteria, and to investigate the effect of a one-year weight loss program with a very low-energy diet (VLED) on circulating levels of AMH.

METHODS

In a prospective cohort-study, were 246 women with severe obesity were screened for PCOS diagnosis with the NIH-criteria, circulating AMH and anthropometry were measured at baseline and after a 12-month weight loss intervention with very low-energy diet (VLED).

RESULTS

Mean BMI was 39.9 ± 4.7 (PCOS), 39.6 ± 4.3 (non-PCOS) P = 0.960. Circulating AMH was higher in women with PCOS (5.47 ± 4.89 µg/L) compared with non-PCOS (2.66 ± 3.71 µg/L) P < 0.001 and was positively correlated with circulating total testosterone in both groups. Next, we performed ROC-analyses, and show that circulating AMH could not discriminate women with PCOS and severe obesity from non-PCOS women with severe obesity. Finally, a one-year weight reduction program does not affect circulating AMH levels despite significant weight loss neither in women with PCOS, nor without PCOS and severe obesity.

CONCLUSION

Women with severe obesity and PCOS have elevated levels of circulating AMH compared to women without the syndrome. AMH-levels could not discriminate women with PCOS from non-PCOS because of low sensitivity and specificity. Significant weight loss was not associated with changes in circulating AMH levels, neither in women with, nor without PCOS and severe obesity. These results imply that in women with severe obesity, a greater weight loss may be needed to improve reproductive features, independent of PCOS diagnosis.

TRIAL REGISTRATION NUMBER

Clinical trial.gov: NCT01319162.

The Role of Individually Selected Diets in Obese Women with PCOS-A Review

Polycystic ovarian syndrome (PCOS) is one of the most common heterogeneous endocrine and metabolic disorders in premenopausal women. It is a complex multifactorial disorder with strong epigenetic and environmental influences, including factors related to eating habits and lifestyle. There is a close relationship between obesity and PCOS. Weight gain and obesity are often clinical symptoms manifested by biochemical markers. Moreover, abdominal obesity in women with PCOS is involved in the development of inflammatory changes. A significant share of balanced therapies correcting the lifestyle of patients is suggested, e.g., with the implementation of appropriate diets to minimize exposure to inflammatory factors and prevent abnormal immune system stimulation. In the case of obese patients with PCOS, planning a diet program and supporting the motivation to change eating habits play an important role to lose weight and lower BMI. Probiotics/synbiotic supplementation may enhance weight loss during the diet program and additionally positively affect metabolic and inflammatory factors by improving the intestinal microbiome.

Proteomic analysis reveals exercise training induced remodelling of hepatokine secretion and uncovers syndecan-4 as a regulator of hepatic lipid metabolism

Objective

Non-alcoholic fatty liver disease (NAFLD) is linked to impaired lipid metabolism and systemic insulin resistance, which is partly mediated by altered secretion of liver proteins known as hepatokines. Regular physical activity can resolve NAFLD and improve its metabolic comorbidities, however, the effects of exercise training on hepatokine secretion and the metabolic impact of exercise-regulated hepatokines in NAFLD remain unresolved. Herein, we examined the effect of endurance exercise training on hepatocyte secreted proteins with the aim of identifying proteins that regulate metabolism and reduce NAFLD severity.

Methods

C57BL/6 mice were fed a high-fat diet for six weeks to induce NAFLD. Mice were exercise trained for a further six weeks, while the control group remained sedentary. Hepatocytes were isolated two days after the last exercise bout, and intracellular and secreted proteins were detected using label-free mass spectrometry. Hepatocyte secreted factors were applied to skeletal muscle and liver ex vivo and insulin action and fatty acid metabolism were assessed. Syndecan-4 (SDC4), identified as an exercise-responsive hepatokine, was overexpressed in the livers of mice using adeno-associated virus. Whole-body energy homeostasis was assessed by indirect calorimetry and skeletal muscle and liver metabolism was assessed using radiometric techniques.

Results

Proteomics analysis detected 2657 intracellular and 1593 secreted proteins from mouse hepatocytes. Exercise training remodelled the hepatocyte proteome, with differences in 137 intracellular and 35 secreted proteins. Bioinformatic analysis of hepatocyte secreted proteins revealed enrichment of tumour suppressive proteins and proteins involved in lipid metabolism and mitochondrial function, and suppression of oncogenes and regulators of oxidative stress. Hepatocyte secreted factors from exercise trained mice improved insulin action in skeletal muscle and increased hepatic fatty acid oxidation. Hepatocyte-specific overexpression of SDC4 reduced hepatic steatosis, which was associated with reduced hepatic fatty acid uptake, and blunted pro-inflammatory and pro-fibrotic gene expression. Treating hepatocytes with recombinant ectodomain of SDC4 (secreted form) recapitulated these effects with reduced fatty acid uptake, lipid storage and lipid droplet accumulation.

Conclusions

Remodelling of hepatokine secretion is an adaptation to regular exercise training that induces changes in metabolism in the liver and skeletal muscle. SDC4 is a novel exercise-responsive hepatokine that decreases fatty acid uptake and reduces steatosis in the liver. By understanding the proteomic changes in hepatocytes with exercise, these findings have potential for the discovery of new therapeutic targets for NAFLD.

•

Exercise training remodels hepatokine secretion.

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Exercise regulated secreted factors improve insulin action in skeletal muscle.

•

Syndecan-4 (SDC4) is a novel exercise-induced hepatokine.

•

SDC4 reduces hepatic fatty acid uptake and hepatic steatosis.

Comparison of the Effect of Milk and Pistachio Snacks on Anthropometric Indices in Overweight or Obese Women: A Randomized Crossover Trial

Background

Weight management is the key to prevent and treat the adverse consequences of overweight and obesity. The aim of this study was to compare the effect of consuming milk and pistachio snacks on anthropometric indices in overweight or obese women.

Methods

In this randomized crossover trial, 60 overweight or obese women with a mean age of 24 ± 4.2 years were randomly divided into two groups. Women in the milk group received 200 mL/day low-fat milk while women in the other group received 30 g/day pistachio for 4 weeks. After a 6-day washout period, the participants received a similar intervention in a crossover manner.

Results

Out of the total 60 participants, 52 completed the study. At the end of the study, the weight of women in the milk group significantly decreased (70.8 ± 8.4 vs. 69.9 ± 8.3, P value = 0.001). No statistically significant changes were observed in the weight of participants in the pistachio group (70.3 ± 8.4 vs. 70.6 ± 8.3, P value = 0.06). Further analyses showed a slightly significant beneficial effect on waist circumference (WC) (P-value =0.068) and body mass index (BMI) in the milk group P value = 0.01).

Conclusions

Based on the observed positive effects of milk intake on weight loss in this crossover study, milk consumption may be considered an appropriate snack in weight loss programs in overweight or obese women.

Association between nutritional guidance or ophthalmological examination and discontinuation of physician visits in patients with newly diagnosed diabetes: A retrospective cohort study using a nationwide database

AIMS/INTRODUCTION

Discontinuation of diabetes care has been studied mostly in patients with prevalent diabetes and not in patients with newly diagnosed diabetes, whose dropout risk is highest. Because enrolling patients in a prospective study will influence adherence, we retrospectively examined whether guideline-recommended practices, defined as nutritional guidance or ophthalmological examination, can prevent patient discontinuation of diabetes care after its initiation.

MATERIALS AND METHODS

We retrospectively identified adults with newly screened diabetes during checkups using a large Japanese administrative claims database (JMDC, Tokyo, Japan) that contains laboratory data and lifestyle questionnaires. We defined discontinuation of physician visits as a follow-up interval exceeding 6 months. We divided the patients into those who received guideline-recommended practices (nutritional guidance or ophthalmology consultation) within the same month as the first visit and those who did not. We calculated propensity scores and carried out inverse probability of treatment weighting analyses to compare discontinuation between the two groups.

RESULTS

We identified 6,508 patients with at least one physician consultation for diabetes care within 3 months after their checkup, including 4,574 patients without and 1,934 with guideline-recommended practices. After inverse probability of treatment weighting, patients with guideline-recommended practices had a significantly lower proportion of discontinuation than those without (17.2% vs 21.8%; relative risk 0.79, 95% confidence interval 0.69-0.91).

CONCLUSIONS

This study is the first to show that after adjustment for both patient and healthcare provider factors, guideline-recommended practices within the first month of physician consultation for diabetes care can decrease subsequent discontinuation of physician visits in patients with newly diagnosed diabetes.

Effects of Synbiotic Supplementation and Lifestyle Modifications on Women With Polycystic Ovary Syndrome

CONTEXT

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women of reproductive age.

OBJECTIVE

This study was designed to evaluate effects of lifestyle modifications and synbiotic supplementation on PCOS.

DESIGN

A randomized (1:1) double-blind, placebo-controlled trial.

SETTING

Academic hospital.

PATIENTS OR OTHER PARTICIPANTS

Overweight and obese women with PCOS were identified according to the Rotterdam criteria. Evaluations were performed at baseline and repeated after 3 months of treatment.

INTERVENTION

Lifestyle modifications in combination with synbiotic supplementation or placebo.

MAIN OUTCOME MEASURES

Change in body mass index (BMI) and testosterone level.

RESULTS

In the placebo group, a 5% decrease in BMI was accompanied by significant decreases of the waist, hip, and thigh circumferences. The synbiotic group experienced an 8% decrease in BMI, which was significantly greater than that in the control group (P = 0.03) and was accompanied by decreases in the waist, hip, and thigh circumferences. Testosterone did not decrease significantly in the placebo group (decrease of 6%), whereas in the synbiotic group it decreased by 32% (P < 0.0001). The decrease of testosterone was significantly greater in the synbiotic group than in the placebo group (P = 0.016).

CONCLUSIONS

Synbiotic supplementation potentiated effects of lifestyle modifications on weight loss and led to significant reduction of serum testosterone.

Predictors of attrition from a weight loss program. A study of adult patients with obesity in a community setting

PURPOSE

Obesity unit attrition is frequent and contributes to treatment failure. Many studies evaluating attrition predictors were part of randomized trials, and different terminology and criteria were used in the engagement field. We aimed to investigate the factors potentially implicated in early (< 12 weeks) and late (> 12 weeks) attrition from an obesity unit in a community setting METHODS: This was a retrospective cohort study of 250 patients with obesity who were followed-up at our obesity unit. Our program included at least 6 meetings in 12 months. Sociodemographic and anthropometric data, and psychometric questionnaires were collected from all participants.

RESULTS

One-hundred thirty-four (53.6%) participants dropped out. Those individuals showed lower BMI, lower overall health status, and increased depression scores. In a multiple regression model, BMI (inversely; OR = 0.90; 95%CI 0.84-0.96) and depression score (directly, OR = 1.05; 1.00-1.10) were associated with attrition risk. Early dropouts (n = 47) had lower weights, smaller waist circumferences and worse mental health scores than late dropouts (n = 87) and more frequently lived alone. When compared to completers, early dropouts had lower weights, BMIs, waist circumferences, overall health and mental status scores, increased depression scores and percentage of individuals living alone. In a multiple regression, lower BMI (OR = 0.83; 0.75-0.92), lower mental status score (OR = 3.17; 1.17-8.59) and living alone (OR = 2.25; 1.02-4.97) were associated with early attrition risk.

CONCLUSION

Lower BMI and increased depression score were associated with attrition. Early attrition was associated with lower weight, decreased mental well-being, and living alone. Individuals with these characteristics might need tailored approaches to enhance their engagement.

LEVEL OF EVIDENCE

Level V, retrospective descriptive study.

Longitudinal effect of nutritional intervention on body weight: A randomized controlled trial

OBJECTIVES

This study evaluates, in the medium and long term (12, 36, and 48 mo), the effect of an intervention to promote consumption of fruit and vegetables on the body weight of Brazilian primary health care users.

METHODS

A follow-up with participants (n = 3414) in a controlled randomized trial was performed in a primary health care service. Those in the control group performed the service's usual intervention (guided physical exercise 3 times/wk), and those in the intervention group additionally participated for 7 mo in collective activities to promote consumption of fruit and vegetables. Sociodemographic, health, and body weight data were collected by face-to-face interview at baseline and after 12 mo. At 36 and 48 mo, weight was obtained by telephone interview and was validated. Adherence to the intervention was assessed by the presence of the actions. Weight change (Δ) was measured by subtracting the weight at each follow-up time from the baseline measurement.

RESULTS

Participants in both groups had a minor weight loss of about 0.1 kg over 12, 36, and 48 mo. The addition of an intervention for consumption of fruit and vegetables did not enhance this effect. Higher weight loss was observed in individuals with obesity classes II and III with low adherence in the intervention and after 36 mo (Δ = -27.1 kg; P = 0.024).

CONCLUSIONS

Participating in the primary health care service contributed to a small reduction in weight, and the intervention for consumption of fruit and vegetables did not enhance this effect. However, greater weight loss was observed in participants with obesity and those who adhered to the intervention.

Unsupervised Exercise Training Was Not Found to Improve the Metabolic Health or Phenotype over a 6-Month Dietary Intervention: A Randomised Controlled Trial with an Embedded Economic Analysis

Ectopic fat leads to metabolic health problems. This research aimed to assess the effectiveness of a hypocaloric diet intervention together with an unsupervised exercise training program in comparison with a hypocaloric diet alone to reduce ectopic fat deposition. Sixty-one premenopausal women with overweight or obesity participated in this controlled trial and were each randomised into either a usual care group (hypocaloric diet) or intervention group (hypocaloric diet + unsupervised exercise training). Ectopic fat deposition, metabolic parameters, incremental costs from a societal perspective and incremental quality-adjusted life years (QALYs) were assessed before, during and after the six-month intervention period. In the total sample, there was a significant decrease in visceral adipose tissue (VAT: -18.88 cm², 95% CI -11.82 to -25.95), subcutaneous abdominal adipose tissue (SAT: -46.74 cm², 95% CI -29.76 to -63.18), epicardial fat (ECF: -14.50 cm³, 95% CI -10.9 to -18.98) and intrahepatic lipid content (IHL: -3.53%, 95% CI -1.72 to -5.32). Consequently, an "adapted" economic analysis revealed a non-significant decrease in costs and an increase in QALYs after the intervention. No significant differences were found between groups. A multidisciplinary lifestyle approach seems successful in reducing ectopic fat deposition and improving the metabolic risk profile in women with overweight and obesity. The addition of unsupervised exercise training did not further improve the metabolic health or phenotype over the six months.

Both high fat and high carbohydrate diets impair vagus nerve signaling of satiety

Obesity remains prevalent in the US. One potential treatment is vagus nerve stimulation (VNS), which activates the sensory afferents innervating the stomach that convey stomach volume and establish satiety. However, current VNS approaches and stimulus optimization could benefit from additional understanding of the underlying neural response to stomach distension. In this study, obesity-prone Sprague Dawley rats consumed a standard, high-carbohydrate, or high-fat diet for several months, leading to diet-induced obesity in the latter two groups. Under anesthesia, the neural activity in the vagus nerve was recorded with a penetrating microelectrode array while the stomach was distended with an implanted balloon. Vagal tone during distension was compared to baseline tone prior to distension. Responses were strongly correlated with stomach distension, but the sensitivity to distension was significantly lower in animals that had been fed the nonstandard diets. The results indicate that both high fat and high carbohydrate diets impair vagus activity.

Oral Recombinant Methioninase Inhibits Diabetes Onset in Mice on a High-fat Diet

BACKGROUND/AIM

We have recently shown that oral recombinant methionase (o-rMETase) prevents obesity in mice on a high-fat (HF) diet. The present study aimed to determine if o-rMETase can inhibit the onset of diabetes in mice on a HF diet.

MATERIALS AND METHODS

The mice on a HF diet were divided into two groups: 1) HF+phosphate buffered saline (PBS) group; 2) HF+o-rMETase group.

RESULTS

The blood glucose level in the HF+PBS group increased to average of 201 mg/dl during the experimental period of 8 weeks. In contrast, the blood glucose level in the HF+o-rMETase group maintained an average of 126 mg/dl (p<0.01, HF+PBS vs. HF+o-rMETase). The glucose tolerance test showed a significant increase in tolerance in the HF+o-rMETase group at 120 min after glucose injection compared to the HF+PBS group (p=0.04). Visceral adipose tissue was significantly less in the HF+o-rMETase group than the HF+PBS group (p=0.05). There was no difference in insulin levels, cholesterol or triglycerides between the HF+PBS and HF+o-rMETase groups.

CONCLUSION

o-rMETase inhibited the onset of diabetes as well as prevented obesity on a high-fat diet, offering a possibility of a new and easy-to-use alternative to severe dieting or insulin injections.

Oral Recombinant Methioninase Prevents Obesity in Mice on a High-fat Diet

BACKGROUND/AIM

obesity is a world-wide recalcitrant problem leading to many diseases. Dietary methionine restriction (MR) has been shown to prevent obesity, but it is an onerous regimen. The present study aimed to determine the effects of oral recombinant methionase (o-rMETase), on preventing obesity in mice on a high-fat diet.

MATERIALS AND METHODS

Male C57BL/6J mice in the control group were fed a control diet (CD) (+6.5% fat) for 25 days, and others were fed a high-fat (HF) diet (+34.3% fat) for 25 days. Then, the mice were divided into three dietary groups: 1) HF + phosphate buffered saline (PBS) group; 2) HF + o-rMETase group; and 3) untreated non-HF group.

RESULTS

The mice on the CD increased in body weight by 14% during experimental period of 25 days; in contrast the mice in the HF+PBS group increased by 33%; however, the mice on the HF+o-rMETase group increased only by 14% (p=0.02, HF+PBS vs HF+o-rMETase).

CONCLUSION

The HF+ o-rMETase group had the same weight increase as untreated mice on a normal fat diet, demonstrating the potential for o-rMETase to eliminate the need for dieting to maintain normal body weight.

Long-Term Effects of Vitamin D Supplementation in Obese Children During Integrated Weight-Loss Programme-A Double Blind Randomized Placebo-Controlled Trial

Background: Vitamin D was studied in regards to its possible impact on body mass reduction and metabolic changes in adults and children with obesity yet there were no studies assessing the impact of vitamin D supplementation during a weight management program in children and adolescence. The aim of our study was to assess the influence of 26 weeks of vitamin D supplementation in overweight and obese children undergoing an integrated 12–months’ long weight loss program on body mass reduction, body composition and bone mineral density. Methods: A double–blind randomized placebo–controlled trial. Vitamin D deficient patients (<30 ng/ml level of vitamin D) aged 6–14, participating in multidisciplinary weight management program were randomly allocated to receiving vitamin D (1200 IU) or placebo for the first 26 weeks of the intervention. Results: Out of the 152 qualified patients, 109 (72%) completed a full cycle of four visits scheduled in the program. There were no difference in the level of BMI (body mass index) change – both raw BMI and BMI centiles. Although the reduction of BMI centiles was greater in the vitamin D vs. placebo group (−4.28 ± 8.43 vs. −2.53 ± 6.10) the difference was not statistically significant (p = 0.319). Similarly the reduction in fat mass—assessed both using bioimpedance and DEXa was achieved, yet the differences between the groups were not statistically significant. Conclusions: Our study ads substantial results to support the thesis on no effect of vitamin D supplementation on body weight reduction in children and adolescents with vitamin D insufficiency undergoing a weight management program.

Predictors for continued participation of employees in structured outpatient obesity intervention programmes

Background

Overweight, obesity and the conditions resulting from them have become one of the major challenges for health systems all over the world. High dropout rates are particularly common among the participants in outpatient obesity intervention programmes (OIP). Limited research has examined retention in OIP.

Methods

Based on the data of a 24-month Bundeswehr outpatient OIP with a total of 630 participants, predisposing factors (n = 30) for continued participation beyond an early stage (0–3 months) and beyond a later stage (0–6 months) were analysed by means of a logistic regression analysis. In order to correct for multiple-comparison, the p-value was adjusted (p* < 0.0017).

Results

Three hundred out of 630 participants continued to participate beyond an early stage and 205 beyond a later stage. Besides an age between 40 and 50 at the beginning of the outpatient OIP, it was possible to show that knowledge of one’s blood pressure and a positive lifestyle prior to participation in the programme (higher level of sporting activity) were predisposing factors for early dropout (>3 months) in the intervention programme.

Discussion

The possible predisposing factors examined accounted for about 35% of the variance in a rough estimate. In order to improve long-term participation in workplace outpatient OIP, the study focused on how the motivation of older people and employees with an unfavourable cardiovascular risk profile could be improved.

Sarcopenic Obesity Predicts Early Attrition in Treatment-Seeking Patients with Obesity: A Longitudinal Pilot Study

Attrition is a major cause of failure in obesity treatment, which is still not fully understood. The identification of factors related to this outcome is of clinical relevance. We aimed to assess the relationship between sarcopenic obesity (SO) and early attrition. Early attrition was assessed at six months, and two groups of patients were selected from a large cohort of participants with overweight or obesity enrolled at the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Body composition was measured using a bioimpedance analyser (Tanita BC-418) and participants at baseline were categorized as having or not having SO. The “dropout group” included 72 participants (cases) compared to 31 participants (controls) in the “completer group”, with the former displaying a higher prevalence of SO than the latter (51.0% vs. 25.8%; p = 0.016). In the same direction, Poisson regression analysis showed that SO increased the relative risk of dropout by nearly 150% (RR = 1.45; 95% CI = 1.10–1.89; p = 0.007) after adjustment for age, gender, body mass index (BMI), age at first dieting, sedentary habits and weight-loss expectation. In conclusion, in a “real-world” outpatient clinical setting, the presence of SO at baseline increases the risk of dropout at six months. New directions of future research should be focused on identifying new strategies to reduce the attrition rate in this population.

Participation of Female Emerging Adults in a Theory- and Evidence-Based Behavioral Weight Loss Program

Emerging adults are less likely to participate in and more likely to drop out of behavioral weight loss programs. Thirty-five female emerging adults who dropped out of a behavioral weight loss program, Weight Loss For Life, completed an online survey. Main reasons for dropout relate to insufficient behavioral skills and unique characteristics of emerging adults, especially when in college (e.g., citing working and getting good grades to be more important than losing weight). Most desired >50% of program online, having virtual groups, and using small groups to model desirable behaviors. Around $140 and $180 seemed sufficient to them to encourage participation in all scheduled treatment sessions and reaching overall weight loss goal, respectively. Future behavioral weight loss programs for emerging adults may consider helping develop time management and task management, decision-making that focuses on longer term outcomes, and immediate tangible rewards similar to what college students typically receive after they complete each class assignment.

The Clinical Testing of the Serious Game Digest-Inn: A Tool to Increase Diet Adherence in Overweight Individuals

Objective: Overweight and obesity are serious health issues often caused by a combination of high-energy consumption and limited physical activity. Diets that focus on limiting the energy intake are effective in the short term, but adherence to a diet is difficult and many individuals drop out prematurely. Materials and Methods: The serious game Digest-Inn is designed to increase diet adherence and to stimulate physical activity. The game was evaluated in three studies, assessing playability (in the general population; N = 76), usefulness (in dietetics practice; N = 7), and effectiveness (in reducing weight in overweight individuals; N = 47). Results: In the 3 studies, in total, 108 individuals played the game. The results show that the game supports dietetics practice and increases the effectiveness of the diet as prescribed by a dietitian. Overweight subjects showed an increased diet adherence (from 45% [in nonplayers] to 100% [in players]), increased weight loss (2.2 kg), and their physical activity was 3800 steps per day, during an average study period of 1 month. Conclusion: These results indicate that the game Digest-Inn is valued by dietitians to support the treatment of overweight clients. The game increases the adherence, and the game mechanics may also be of use for other conditions that suffer from low compliance and treatment adherence.

Adherence and barriers in e-health self-control training for enhancing childhood multidisciplinary obesity treatment

Training self-control as the assumed underlying mechanism for weight loss is a promising pathway for improving long-term outcomes of childhood multidisciplinary obesity treatment (MOT). The present study is the first to analyse adherence to e-health self-control training in paediatric obesity. We hypothesized that low adherence would relate to child characteristics and to contextual treatment barriers. Participants were recruited as a part of a larger randomized controlled trial, evaluating an e-health self-control training during inpatient MOT (intensive phase) and its outpatient aftercare (booster phase). A number of 68 youngsters with severe obesity between 11 to 19 years old were included in the present study. Excellent adherence was observed in the intensive phase during inpatient MOT, but rates decreased in the booster phase. As predicted, the low adherence group had a significantly higher weight status throughout the entire study period. Differences in contextual treatment barriers did not appear. Further in-depth analysis showed that the low adherence group frequently experienced practical obstacles. The end of inpatient MOT and high weight status can be considered important risk factors for low adherence in an additional self-control training aimed at facilitating weight loss.

Nutritional intervention may improve migraine severity: a pilot study

OBJECTIVE

Although some studies have investigated the role of nutritional intervention on migraine, they had focused on triggers or on weight change and, to the best of our knowledge, none studied diet quality.

OBJECTIVE

To investigate whether nutritional intervention focused on improving diet quality and healthy weight can promote improvement in clinical parameters of women with migraine.

METHODS

Non-controlled and non-randomized intervention study conducted for 90 days. Women received an individualized diet meal plan and nutritional orientation according to their nutritional diagnosis. Anthropometric, clinical and nutritional data were measured once a month. Diet energy content and macronutrients were evaluated using 24-hour dietary recall. Diet quality was assessed through the Brazilian Healthy Eating Index-Revised (BHEI-R). The Migraine Disability Assessment and Headache Impact Test version 6 were used to assess the severity of migraine, and the Beck Depression Inventory evaluated depressive symptoms.

RESULTS

Fifty-two women aged 44.0 ± 13.0 years were enrolled. Anthropometric characteristics, energy, macronutrients and fiber intake did not change after intervention. However, the BHEI-R scores improved after 60 and 90 days of intervention. Concurrent to this, the Beck Depression Inventory scores and Headache Impact Test scores decreased after 60 and 90 days, respectively. The change in the BHEI-R score was negatively correlated with the migraine severity as assessed by the Headache Impact Test at the end of the intervention.

CONCLUSIONS

We concluded that the management of diet quality may be a good strategy for improving migraine severity, regardless of the nutritional status and weight change.

Methods for the Selection of Covariates in Nutritional Epidemiology Studies: A Meta-Epidemiological Review

BACKGROUND

Observational studies provide important information about the effects of exposures that cannot be easily studied in clinical trials, such as nutritional exposures, but are subject to confounding. Investigators adjust for confounders by entering them as covariates in analytic models.

OBJECTIVE

The aim of this study was to evaluate the reporting and credibility of methods for selection of covariates in nutritional epidemiology studies.

METHODS

We sampled 150 nutritional epidemiology studies published in 2007/2008 and 2017/2018 from the top 5 high-impact nutrition and medical journals and extracted information on methods for selection of covariates.

RESULTS

Most studies did not report selecting covariates a priori (94.0%) or criteria for selection of covariates (63.3%). There was general inconsistency in choice of covariates, even among studies investigating similar questions. One-third of studies did not acknowledge potential for residual confounding in their discussion.

CONCLUSION

Studies often do not report methods for selection of covariates, follow available guidance for selection of covariates, nor discuss potential for residual confounding.

Barriers to and facilitators for adherence to nutritional intervention: Consumption of fruits and vegetables

OBJECTIVES

The aim of this study was to investigate the barriers and facilitators for the adherence of participants to a nutritional intervention.

METHODS

A randomized controlled trial was carried out with participants from the Health Academy Program in Belo Horizonte, MG, Brazil. The intervention (7 mo) was based on the Transtheoretical Model and on Paulo Freire's pedagogy and offered 12 education activities with the purpose of promoting the consumption of fruits and vegetables. Adherene was determined by calculating the participation percentage (attendance at activities/number of activities).

RESULTS

In all, 1483 individuals participated and the average adherence was 58.3%. Low adherence was demonstrated by 24.3%, medium adherence by 26.5%, and high adherence by 49.2% of the participants. Adherence was associated with aging (odds ratio [OR], 1.97; 95% CI, 1.33-2.94), being unemployed (OR, 0.75; 95% CI, 0.58-0.95), not being under psychiatric treatment (OR, 0.77; 95% CI, 0.63-0.95), participant body satisfaction (OR, 1.27; 95% CI, 1.02-1.58) and participant attendance at the Health Academy Program for >1 y (OR, 2.78; 95% CI, 2.17-3.56). The qualitative analysis revealed the following facilitators for adherence: service structure, intervention methodology, bond-building among users and professionals, family support, and patient-associated aspects. The barriers to adherence included work, self-care, and care for another.

CONCLUSION

Adherence to the intervention was high, and the patient-associated aspects, the logistics of the Health Academy Program, and the methodology appeared to contribute to adherence. However, the timetable was a barrier for those who were working and for those who support their families.

Desenvolvimento de material educacional interdisciplinar para prevenção e tratamento da obesidade

Introdução: a obesidade é uma doença crônica e complexa de caráter epidêmico, sendo fator de risco para diversas doenças. O município de Juiz de Fora possui uma prevalência maior de obesidade que a da capital do Estado de Minas Gerais e também à média nacional, sendo necessárias estratégias de estímulo às práticas de vida saudáveis, pautadas nas ações educativas em saúde, envolvendo orientação nutricional, prática de atividades físicas, além da abordagem de aspectos biopsicossociais e culturais do indivíduo. Objetivo: desenvolvimento de programa de educação continuada e estímulo ao autocuidado do indivíduo em relação às suas condições de saúde. Relato de experiência: com base nas demandas dos pacientes atendidos nas consultas individuais, grupos operativos e salas de espera, uma cartilha educativa (“Guia de Prevenção – Prevenindo e tratando o excesso de peso”) foi criada pela equipe multidisciplinar do ambulatório de prevenção e tratamento da obesidade de um hospital universitário. Este material foi lançado oficialmente em setembro de 2018 e tem possibilitado a divulgação de vários temas relacionados à obesidade, como diagnóstico, prevenção e mudança do estilo de vida. Os principais beneficiários desse projeto são os pacientes assistidos nos ambulatórios, contudo poderá auxiliar em ações extra-muros, como atividades em escolas públicas municipais e ações pontuais no campus universitário, por exemplo, no Dia Internacional de Combate à Obesidade. Discussão: o material foi bem aceito e as principais dúvidas após a leitura foram em relação à definição de obesidade e o fato de não reconhecerem a fisiopatologia da doença como uma interação de fatores genéticos e ambientais. Conclusão: ações educativas complementares à prevenção e tratamento da obesidade, envolvendo os vários aspectos do cuidado, têm grande aceitação pela população abordada e representam ferramentas com potencial de melhora do autocuidado e autonomia do indivíduo.

Smoking and weight loss among smokers with overweight and obesity in Look AHEAD

Smoking cessation is associated with increases in body weight, but little is known about the relationship between participation in a weight loss intervention and smoking.

OBJECTIVE

To determine whether (a) weight losses at 1 year differ as a function of baseline smoking status (never smoker, current smoker, ex-smoker) and (b) participation in a weight loss intervention affects smoking behavior.

METHOD

This analysis addressed these questions using the publicly available database from Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) and diabetes support and education (DSE; control condition) among individuals with overweight/obesity and Type 2 diabetes, and included 4,387 participants who had self-reported smoking and objective weight measures available at baseline and at 1 year.

RESULTS

Although participants in ILI lost a significantly greater percentage of weight than those in DSE at 1 year (ILI, M = -8.8%, SD = 6.8; DSE, M = -0.7%, SD = 4.7), there were no differences in weight loss outcomes between never smokers (n = 2,297), ex-smokers (n = 2,115), and current smokers (n = 188) within either condition. Participation in ILI was not associated with compensatory smoking or likelihood of quitting smoking or relapsing.

CONCLUSIONS

Smokers in a weight loss intervention had reductions in weight that were comparable to individuals who did not smoke without any evidence of compensatory smoking to manage eating and appetite. Smokers with obesity should be encouraged to pursue weight loss without concerns regarding the impact on smoking behavior. (PsycINFO Database Record

Alexithymia Predicts Attrition and Outcome in Weight-Loss Obesity Treatment

Obesity is a psychosomatic condition characterized by a complex interaction of biological and psychological factors and a large body of research has aimed to identify variables limiting efficacy and determining high attrition rates in weight loss programs. In this study, we used the Diagnostic Criteria for Psychosomatic Research (DCPR), designed to broaden the clinician's perspective on patients' problems by providing additional clinical information not found in the more traditional psychiatric classification, to predict psychosomatic variables that may limit efficacy and determine attrition in clinical interventions with people with obesity. We evaluated 82 consecutive participants with obesity at baseline for psychopathology, psychosomatic correlates, psychological distress, and eating-related symptoms before entering a weight loss program. Regression models were used to assess attrition and outcome at a 6-month follow-up and per-protocol and intention-to-treat analyses were performed. DPCR alexithymia significantly predicted attrition (OR = 6.9), and unsuccessful weight-loss (OR = 11.3). These findings suggest that the identification of psychosomatic factors, in addition to psychological and psychopathological factors, may predict adherence to weight-loss programs.

A path model analysis on predictors of dropout (at 6 and 12 months) during the weight loss interventions in endocrinology outpatient division

INTRODUCTION

This study aimed to identify the dropout rate at 6 and 12 months from the first outpatient visit, and to analyze dropout risk factors among the following areas: biochemical examinations, anthropometric measures, psychological tests, personal data, and life attitude such as smoking, physical activity, and pathologies.

METHODS

This is a retrospective longitudinal observational study. Patients undergo an outpatient endocrinology visit, which includes collecting biographical data, anthropometric measurements, physical and pathological history, psychological tests, and biochemical examinations.

RESULTS

The sample consists of 913 subjects (682 women and 231 men), with an average age of 50.88 years (±15.80) for the total sample, with a BMI of 33.11 ± 5.65 kg/m². 51.9% of the patients abandoned therapy at 6 months after their first visit, and analyzing the dropout rate at 12 months, it appears that 69.5% of subjects abandon therapy. The main predictor of dropout risk factors at 6 and 12 months is the weight loss during the first 3 months (p < 0.05). As regards the hematological predictors, white blood cell and iron level stated dropout at 12 months. Patients who introduced physical activity had a reduction of - 17% (at 6 months) and -13% (at 12 months) of dropout risk (p < 0.05). As regards the "worker" status, patients classified as"retired" had a decrease risk of dropout vs. other categories of worker (i = 0.58; p < 0.05). Dropout risk at 12 months decrease in patients with a previous history of cancer, Endocrine and psychic and behavioral disorders (p < 0.001).

CONCLUSIONS

The main factor that predisposes patients to continue therapy or to abandon it is the success (or failure) of the diet in the initial period, based on weight lost (or not lost) in the early months of the initiation of therapy. Furthermore, considerable differences were found in different categories of "workers", and with previous "pathologies". The level of physical activity and previous diseases also seem to be predictors of dropout.

The Role of Choice in Weight Loss Strategies: A Systematic Review and Meta-Analysis

Effective strategies to achieve weight loss and long-term weight loss maintenance have proved to be elusive. This systematic review and meta-analysis aims to explore whether the choice of weight loss strategy is associated with greater weight loss. An electronic search was conducted using the MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), EMBASE (Excerpta Medica database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO (Database of Abstracts of Literature in the Field of Psychology, produced by the American Psychological Association and distributed on the association's APA PsycNET) databases for clinical trials and randomized controlled trials, investigating the role of choice in weight loss strategies. A total of nine studies were identified as meeting the pre-specified criteria. All of the studies included a 'Choice' or preference arm and a 'No Choice' arm or group who did not receive their preference as a control. A total of 1804 subjects were enrolled in these studies, with weight loss observed in both experimental and control groups of all studies, irrespective of dietary intervention, study duration, or follow-up length. Twelve interventions in nine trials were used for the meta-analysis, with results indicating a greater weight loss in the control groups, 1.09 ± 0.28 (overall mean difference in weight loss between groups ± standard error; p = 0). There was no significant effect of duration or attrition. In this meta-analysis, the choice of weight loss strategy did not confer a weight loss benefit.

Changes in weight, physical activity and its theory-based psychosocial correlates within an adolescent bariatric clinic: contrasts with adults with extreme obesity

Albeit their practical implications, psychosocial correlates of physical activity and related weight loss in the treatment of extreme obesity have been only sparsely addressed in adults; and even more minimally focused upon in adolescents. This research contrasted results of a 6-month social cognitive theory-based physical activity-support protocol along with standard nutrition counseling in groups of adolescents (n = 19; age_mean = 15.4 years) and adults (n = 26, age_mean = 44.7 years) with class 3 (extreme) obesity [overall body mass index (BMI)_mean = 53.4 kg/m², standard deviation (SD) = 8.2]. Although baseline total mood disturbance scores were significantly greater in both groups when contrasted with age-corresponding normative values, between-group scores did not significantly differ. BMI and physical activity changes over 3 and 6 months were significantly more favorable in the adult group. There were significant overall improvements in exercise self-efficacy, physical activity self-regulation and total mood disturbance scores, however, the self-efficacy and self-regulation increases were significant in only the adult group. Inverse relationships between changes in physical activity and BMI were stronger in the adult group. Regardless of group, simultaneous entry of changes in exercise self-efficacy, physical activity self-regulation and total mood disturbance scores, over both 3 and 6 months, significantly predicted physical activity changes (R²-values = 0.45-0.75, p-values < 0.001). In each model, self-regulation change was the most salient of those three psychosocial predictors. Although findings suggested that psychosocial correlates of physical activity, leading to weight change, are similar in adolescents and adults with extreme obesity, facilitation of larger effect sizes and/or foci on additional theory-based determinants may be required for clinically meaningful treatment outcomes in adolescents.

Initial engagement and attrition in a national weight management program: demographic and health predictors

Inconsistent attendance and participant withdrawal limit the effectiveness of weight control programs, but little is known about predictors of initial and ongoing engagement. The purpose of this study was to identify these predictors with respect to the Veterans Affairs MOVE!® program, using medical record data. Logistic regression models were used to predict initial and ongoing engagement (n = 39,862 and 1985, respectively). Those who initially engaged in MOVE!® (vs. did not) were more likely to have high BMIs, to be female, live closer to the medical center, and receive health benefits from the VA; they also were less likely to use tobacco (ps < 0.02). Older veterans were more likely to continue to engage (p < 0.001), with trends toward continued engagement for those with (vs. without) benefits and higher BMIs (ps < 0.10). Findings highlight characteristics that may inform program improvements that promote ongoing engagement and prevent dropouts in a weight management programs.

A Self-Regulation-Based eHealth Intervention to Promote a Healthy Lifestyle: Investigating User and Website Characteristics Related to Attrition

BACKGROUND

eHealth interventions can reach large populations and are effective in increasing physical activity (PA) and fruit and vegetable intake. Nevertheless, the effects of eHealth interventions are overshadowed by high attrition rates. Examining more closely when users decide to leave the intervention can help eHealth developers to make informed decisions about which intervention components should be reshaped or simply removed. Investigating which users are more likely to quit an intervention can inform developers about whether and how their intervention should be adapted to specific subgroups of users.

OBJECTIVE

This study investigated the pattern of attrition in a Web-based intervention to increase PA, fruit, and vegetable intake. The first aim was to describe attrition rates according to different self-regulation components. A second aim was to investigate whether certain user characteristics are predictors for start session completion, returning to a follow-up session and intervention completion.

METHODS

The sample consisted of 549 adults who participated in an online intervention, based on self-regulation theory, to promote PA and fruit and vegetable intake, called "MyPlan 1.0." Using descriptive analysis, attrition was explored per self-regulation component (eg, action planning and coping planning). To identify which user characteristics predict completion, logistic regression analyses were conducted.

RESULTS

At the end of the intervention program, there was an attrition rate of 78.2% (330/422). Attrition rates were very similar for the different self-regulation components. However, attrition levels were higher for the fulfillment of questionnaires (eg, to generate tailored feedback) than for the more interactive components. The highest amount of attrition could be observed when people were asked to make their own action plan. There were no significant predictors for first session completion. Yet, two subgroups had a lower chance to complete the intervention, namely male users (OR: 2.24, 95% CI=1.23-4.08) and younger adults (OR: 1.02, 95% CI=1.00-1.04). Furthermore, younger adults were less likely to return to the website for the first follow-up after one week (OR: 1.03, 95% CI=1.01-1.04).

CONCLUSIONS

This study informs us that eHealth interventions should avoid the use of extensive questionnaires and that users should be provided with a rationale for several components (eg, making an action plan and completing questions). Furthermore, future interventions should focus first on motivating users for the behavior change before guiding them through action planning. Though, this study provides no evidence for removal of one of the self-regulation techniques based on attrition rates. Finally, strong efforts are needed to motivate male users and younger adults to complete eHealth interventions.

Factors behind nonadherence to diet regimens among obese adults in Tanta, Egypt: a case-control study

BACKGROUND

Nonadherence to diet regimens is a major cause of treatment failure in the field of obesity management. It varies according to the study design and the type of intervention. In weight loss clinical trials, nonadherence rates range from 10 to 80%. Strategies to reduce dropout rates rely on precise identification of factors leading to premature program termination. The aim of this research was to study factors behind nonadherence to diet regimens among obese adults in Tanta, Egypt.

PARTICIPANTS AND METHODS

A retrospective, case-control study was carried out during the year 2014 in an obesity management private clinic in Tanta, Gharbia Governorate, Egypt. The study included two groups of 150 participants each (adherents and nonadherents) matched for sex and BMI. Self-administered questionnaires were used to collect data concerning sociodemographic characteristics, weight changes, dieting, and behavioral, psychological, and medical factors. Personal perspectives on potential factors contributing to nonadherence to diet regimens were also investigated.

RESULTS

Factors significantly associated with probabilities high probability of to loss of adherence to diet regimens were as follows: younger age, urban residence, higher educational levels, obesity of grades I and III, a higher frequency of previous weight loss trials, consumption of fruits and vegetables less than that recommended (<5 times/day), higher weight loss expectations, and binge eating. The most common personal perspectives on causes limiting adherence to diet regimens were as follows: unsatisfactory results (37.3%), difficulties in dieting practices (33.3%), logistics (30.0%), and fading of motives (27.3%).

CONCLUSION AND RECOMMENDATIONS

Obese individuals seeking weight reduction with young age, urban residence, higher educational levels, a higher frequency of previous weight loss trials, higher weight loss expectations, and those with perceived unsatisfactory results are more prone to lose their adherence to diet regimens. Individuals with factors of nonadherence should receive extra care to avoid their withdrawal from diet programs and to improve clinical outcomes.

Weight loss in videoconference and in-person iDiet weight loss programs in worksites and community groups

OBJECTIVE

To examine the association of program delivery factors with weight loss (WL) in enrollees in iDiet^® , a commercial WL program.

METHODS

Data were from 644 adults enrolling in an 11-week group WL program and 461 who reported weight to 11 weeks (complete reporters). Predictors of %WL were analyzed using ANCOVA, including meeting type (in-person vs. videoconference), participant type (worksite employees vs. community members), age, gender, BMI, and payment structure.

RESULTS

Mean starting BMI was 32.4 ± 7.1 (mean ± SD); WL was 6.1 ± 3.9% in all enrollees in an intention-to-treat analysis and 7.4 ± 3.4% in complete reporters. Videoconference participants, older adults, and enrollees in incentivized programs were more likely to be complete reporters (P < 0.004). %WL at 11 weeks was not associated with gender, starting BMI, or videoconference versus in-person groups. Worksite participants had greater %WL than community participants (+1.2%, P < 0.001), and there was no significant difference in %WL between programs paid by the employee or employer. Greater %WL was achieved by individuals ≥30 versus < 30 years (+2.2%, P < 0.001) and by those enrolling in January-March versus April-June (+1.4%, P = 0.02).

CONCLUSIONS

iDiet participants had clinically impactful mean WL. The observed high mean WL in worksites and videoconference-delivered programs broadens options for scalable WL program implementation.

Determinants of adherence to lifestyle intervention in adults with obesity: a systematic review

Lifestyle intervention programmes are efficacious in the management of obesity but often report poor attendance and adherence rates that hinder treatment effectiveness and health outcomes. The aim of this systematic review is to identify (i) barriers to behaviour change and (ii) predictors of adherence to lifestyle intervention programmes in adults with obesity. Studies were identified by systematically reviewing the literature within Medline, PsycINFO, CINAHL, SPORTDiscus and Web of Science from inception to August 2016. Barriers to behaviour change include poor motivation; environmental, societal and social pressures; lack of time; health and physical limitations; negative thoughts/moods; socioeconomic constraints; gaps in knowledge/awareness; and lack of enjoyment of exercise. The most prominent predictors of adherence include early weight loss success, lower baseline body mass index (BMI), better baseline mood, being male and older age. The findings within this review provide novel insight to clinicians working in obesity and have important implications for lifestyle intervention programme design. Barriers to behaviour change need to be addressed early in treatment, with lifestyle intervention individualized accordingly. Predictors of adherence should also be taken into careful consideration, with negative moods and unrealistic weight loss expectations discussed at the outset. If adherence is improved, treatment effectiveness, health outcomes and the ultimate burden of chronic diseases could also be improved.

Behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity: a systematic review and meta-analysis

Poor adherence to lifestyle intervention remains a key factor hindering treatment effectiveness and health outcomes for adults with obesity. The aim of this systematic review and meta-analysis is to determine if behavioural treatment strategies (e.g. goal setting, motivational interviewing, relapse prevention, cognitive restructuring etc.) improve adherence to lifestyle intervention programmes in adults with obesity. Randomized controlled trials that investigated the use of behavioural treatment strategies in obesity management were identified by systematically reviewing the literature within Medline, PsycINFO, CINAHL, SPORTDiscus and Web of Science from their inception to August 2016. This meta-analysis shows that behavioural treatment interventions have a significant positive effect on session attendance (percentage) and physical activity (total min/week) in adults with obesity (M = 17.63 (95% confidence interval (CI) = 10.77, 24.50), z =5.0337, P < 0.0001 and M = 105.98 (95% CI = 58.64, 153.32), z =4.3878, P < 0.0001, respectively). This meta-analysis of randomized controlled trials provides evidence that behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity. These strategies should be routinely incorporated into lifestyle intervention, obesity management and weight loss programmes with the aim of improving engagement and adherence. If adherence were improved, treatment effectiveness, health outcomes and the ultimate burden of chronic disease could also be improved.

Supervised vs. self-selected physical activity for individuals with diabetes and obesity: the Lifestyle Gym program

The effectiveness of different programs of physical activity outside randomized studies is difficult to determine. We carried out an audit in two different units where either a supervised physical activity (PA) program or a self-selected PA program was in use in individuals with type 2 diabetes or obesity. The supervised PA cohort (n = 101) received progressive gym training (120 min, twice a week for 13 weeks) by a dedicated team, with nutritional counseling during resting periods. The self-selected PA cohort (n = 69) was enrolled in a 13-week cognitive-behavioral program (120 min/week, in groups of 12-15 individuals), chaired by an expert team. Body weight and physical fitness (6-min walk test) were measured at baseline and after 6 and 12 months. Outcome measures were attrition, weight loss ≥10 % initial body weight, 10 % increase in 6-min walk test; their association with a PA program was tested by logistic regression analysis. Attrition rate was lower in the supervised PA group (28 vs. 45 % than in the self-selected cohort, P = 0.023). After adjustment for confounders, the supervised PA program was associated with a lower risk of attrition at 1 year (odds ratio 0.45; 95 % confidence interval, 0.21-0.98) at logistic regression analysis. Body weight similarly decreased in both groups (more rapidly in the supervised PA cohort); also physical fitness improved in a similar way, and no differences in achieved targets of body weight (supervised, 31 %; self-selected, 18 %; P = 0.118) or fitness (supervised, 62 %; self-selected, 49 %; P = 0.312) were demonstrated. Different PA programs produce very similar health benefits, but an initially supervised program has lower attrition rates, which might translate into better outcomes in the long term.

Results of a course based obesity intervention program during work

BACKGROUND

Overweight and obesity are becoming more and more relevant for armed forces in westernized countries, especially with respect to the impact on recruitment and soldiers' performance. The German Armed Forces have been organizing a Military Obesity Intervention Program (OIP) in Warendorf, Germany, since 2001. In addition to the existing outpatient program, a course version was offered. This course version is of interest since it offers a potential alternative to outpatient programs.

OBJECTIVE

To analyse the results obtained from the course version of the OIP and comparing these to other OIPs.

METHODS

Retrospective analysis of the course version of the OIP, starting in 2001, based on an intention-to-treat analysis.

RESULTS

334 participants showed significant improvement (p <  0.05) in bodyweight (-3.4±6.6  kg), body mass index (-1.0±2.0  kg/m2), waist circumference (-3.8±6.4  cm), systolic and diastolic blood pressure (-5.6±18.0/-3.3±12.8  mm Hg), physical capacity (+11.4±32.6 Watt), total cholesterol (-0.16±0.94  mmol/l), HDL (+0.04±0.23  mmol/l), LDL (-0.16±0.80  mmol/l), uric acid (-31.2±69.3 μmol/l) and hemoglobin A1c (-0.13±0.52%). The entire OIP course was completed by 180 participants (53.9%). 27.5% of all 334 participants had reduced their body weight by 5% or more during their participation in the OIP.

CONCLUSIONS

In this specific OIP only a small number of obese patients reduced their bodyweight, even though the examined parameters improved significantly. Therefore, greater efforts need to be undertaken in order to prevent overweight and obesity in the military in addition to the implemented obesity intervention programs.

Study Protocol: A randomized controlled trial evaluating the effect of family-based behavioral treatment of childhood and adolescent obesity-The FABO-study

Background

The purpose of the FABO-study is to evaluate the effect of family-based behavioral social facilitation treatment (FBSFT), designed to target children’s family and social support networks to enhance weight loss outcomes, compared to the standard treatment (treatment as usual, TAU) given to children and adolescents with obesity in a routine clinical practice.

Methods

Randomized controlled trial (RCT), in which families (n = 120) are recruited from the children and adolescents (ages 6–18 years) referred to the Obesity Outpatient Clinic (OOC), Haukeland University Hospital, Norway. Criteria for admission to the OOC are BMI above the International Obesity Task Force (IOTF) cut-off ≥ 35, or IOTF ≥ 30 with obesity related co-morbidity. Families are randomized to receive FBSFT immediately or following one year of TAU. All participants receive a multidisciplinary assessment. For TAU this assessment results in a plan and a contract for chancing specific lifestyle behaviors. Thereafter each family participates in monthly counselling sessions with their primary health care nurse to work on implementing these goals, including measuring their weight change, and also meet every third month for sessions at the OOC. In FBSFT, following assessment, families participate in 17 weekly sessions at the OOC, in which each family works on changing lifestyle behaviors using a structured cognitive-behavioral, socio-ecological approach targeting both parents and children with strategies for behavioral maintenance and sustainable weight change.

Outcome variables include body mass index (BMI; kg/m²), BMI standard deviation score (SDS) and percentage above the IOTF definition of overweight, waist-circumference, body composition (bioelectric impedance (BIA) and dual-X-ray-absorptiometry (DXA)), blood tests, blood pressure, activity/inactivity and sleep pattern (measured by accelerometer), as well as questionnaires measuring depression, general psychological symptomatology, self-esteem, disturbed eating and eating disorder symptoms. Finally, barriers to treatment and parenting styles are measured via questionnaires.

Discussion

This is the first systematic application of FBSFT in the treatment of obesity among youth in Norway. The study gives an opportunity to evaluate the effect of FBSFT implemented in routine clinical practice across a range of youth with severe obesity.

Trial registration

ClinicalTrails.gov NCT02687516. Registered 16th of February, 2016

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3755-9) contains supplementary material, which is available to authorized users.

Five-year outpatient programme that provided children with continuous behavioural obesity treatment enjoyed high success rate

AIM

Results from long-time follow-up of obesity treatment in early childhood are lacking. We investigate long-term continuous behavioural childhood obesity treatment and factors of importance for treatment effect.

METHOD

A five-year longitudinal retrospective controlled study of children aged five to 13 years in obesity treatment, divided into three groups depending on age at start of treatment. Outcome is presented as change in degree of obesity, body mass index standard deviation score (BMI SDS), change in weight status and decrease of ≥0.5 BMI SDS units, in relation to a age-matched obese comparison group.

RESULTS

In total, 220 children (46% females) were included. After five years of treatment, the decrease in BMI SDS was significant in all age groups with the largest effect in age group 4-6 years. Compared to the comparison group (n = 369), the decline in BMI SDS was greater (p = 0.001). After five years of treatment, 48% of the patients were cured from their obesity and 72% reached a decline of 0.5 BMI SDS units. Age at start of treatment was the only factor affecting treatment efficacy.

CONCLUSION

The ability to reach a significant weight loss in a paediatric outpatient clinic is promising through a long-term behavioural obesity treatment.

Weight loss practices among newly enrolling clients in a commercial weightloss program in Ghana

BACKGROUND

In Ghana, obesity is showing a rising trend and there are weight loss initiatives being practised by individuals. However, the levels of commitment to such programs and the reasons for discontinuing have not been assessed. The objectives of this study were to investigate the weight loss practices of participants and reasons for quitting chosen weight loss programs.

METHODS

This was a cross-sectional study involving 50 subjects conveniently selected from people who were enrolling into a commercial weight loss program. A questionnaire was used to collect data on past weight loss practices and reasons for abandoning chosen programs. Data analysis was conducted using simple frequency and descriptive tests of the Excel software.

RESULTS

More than half of the subjects (66%) had undertaken a weight loss practice before enrolment in study. Of these, 88.5% abandoned the strategy before the achievement of their desired weight goal. The three common programs that were practised were internet based diets (67.9%), commercial weight loss shakes (42.9%) and exercises (28.6%). Reasons given for abandoning programs included lack of sustainability (50%), lack of determination on the part of the client (15%), boredom with program (10%), not achieving desired results (10%), safety concerns (10%), and getting pregnant (5%).

CONCLUSIONS

The findings suggest that future weight loss programs can be effective and have reduced attrition rates if they are designed to achieve sustainable dietary and other lifestyle changes, as well as boost motivation for weight loss.

Predictors of short- and long-term adherence with a Mediterranean-type diet intervention: the PREDIMED randomized trial

Background

Dietary intervention success requires strong participant adherence, but very few studies have examined factors related to both short-term and long-term adherence. A better understanding of predictors of adherence is necessary to improve the design and execution of dietary intervention trials. This study was designed to identify participant characteristics at baseline and study features that predict short-term and long-term adherence with interventions promoting the Mediterranean-type diet (MedDiet) in the PREvención con DIeta MEDiterránea (PREDIMED) randomized trial.

Methods

Analyses included men and women living in Spain aged 55–80 at high risk for cardiovascular disease. Participants were randomized to the MedDiet supplemented with either complementary extra-virgin olive oil (EVOO) or tree nuts. The control group and participants with insufficient information on adherence were excluded. PREDIMED began in 2003 and ended in 2010. Investigators assessed covariates at baseline and dietary information was updated yearly throughout follow-up. Adherence was measured with a validated 14-point Mediterranean-type diet adherence score. Logistic regression was used to examine associations between baseline characteristics and adherence at one and four years of follow-up.

Results

Participants were randomized to the MedDiet supplemented with EVOO (n = 2,543; 1,962 after exclusions) or tree nuts (n = 2,454; 2,236 after exclusions). A higher number of cardiovascular risk factors, larger waist circumference, lower physical activity levels, lower total energy intake, poorer baseline adherence to the 14-point adherence score, and allocation to MedDiet + EVOO each independently predicted poorer adherence. Participants from PREDIMED recruiting centers with a higher total workload (measured as total number of persons-years of follow-up) achieved better adherence. No adverse events or side effects were reported.

Conclusions

To maximize dietary adherence in dietary interventions, additional efforts to promote adherence should be used for participants with lower baseline adherence to the intended diet and poorer health status. The design of multicenter nutrition trials should prioritize few large centers with more participants in each, rather than many small centers.

Trial registration

This study was registered at controlled-trials.com (http://www.controlled-trials. com/ISRCTN35739639). International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005.

Trial design: parallel randomized trial.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0394-6) contains supplementary material, which is available to authorized users.

Review of 3-year outcomes of a very-low-energy diet-based outpatient obesity treatment programme

Obesity is a complex disorder that requires a multidisciplinary treatment approach. This review evaluated 3-year outcomes of a very-low-energy diet (VLED)-based programme at a tertiary hospital multidisciplinary weight management clinic. Medical records of all patients who agreed to undertake the VLED programme and who did not undergo bariatric surgery during the 3-year follow-up period were examined. Baseline data collection included demographic and anthropometric characteristics, childhood onset of obesity and co-existing medical conditions. Weight was modelled using a linear mixed effects analysis. Logistic regression analyses were used to model the probability of continuing to attend the clinic and to identify pre-treatment factors associated with longer duration of attendance. Data from 1109 patients were included. A total of 231 patients (19.2%) were still attending the clinic 3 years after their initial appointment. Mean weight loss among patients who attended the clinic for 3 years was 6.4 kg (3.5%, 95% confidence interval [CI] 2.8, 4.2%). People who were prescribed pharmacotherapy maintained greater weight loss at 3 years (7.7% vs. 2.3% without pharmacotherapy, 95% CI for difference 3.9, 7.0%). People who had an onset of obesity in childhood, who had co-existing hypertension or coronary artery disease, and who did not currently smoke were more likely to continue to attend the clinic for up to 3 years. In summary, in an outpatient weight management clinic, patients who undertook a VLED-based programme and continued in follow-up achieved a clinically significant weight loss at 3 years, particularly if pharmacotherapy was used for weight loss maintenance.